Fraud and Abuse

Topic Outline

How Large is the Fraud and Abuse Problem?

Berwick, Donald and Hackbarth, Andrew. Eliminating Waste in U.S. Health Care. JAMA. April 11, 2012. The annual cost of fraud in 2011 ranged from $82 to $272 billion of health spending (3.1 to 10.1% of health spending).
Uwe E. Reinhardt. How Much Fraud and Abuse Is There in U.S. Health Care, The New York Times, 3/5/2012.
Shantanu Agrawal and Peter Budetti. Physician Medical Identity Theft, Journal of the American Medical Association, 2/1/2012.
Peter Budetti and Deborah Taylor. Waste and Abuse in Government Health Care, Centers for Medicare and Medicaid Services, 4/5/2011.
Alliance for Health Reform. Program Integrity: How Much Money Can Combating Health Care Fraud and Abuse Save? March 5, 2012.
Insurance Research Council (IRC), 2008.
It is estimated that in 2007 claims fraud added between US $4.8 billion to $6.8 billion to automobile injury insurance claims, or around 13-18% of total claim payments.

Berwick, Donald and Hackbarth, Andrew. Eliminating Waste in U.S. Health Care. JAMA. April 11, 2012. The annual cost of Medicare and Medicaid fraud in 2011 ranged from $30 to $98 billion of health spending on these programs ($962 billion was spent on both programs in 2011, so these figures represent 3.1 to 10.2% of program spending).
Government Accountability Office. Medicare Fraud, Waste, and Abuse – Challenges and Strategies for Preventing Improper Payments. 6/15/2010
Centers for Medicare & Medicaid Services. Medicare Fraud & Abuse: Prevention, Detection, and Reporting, 10/1/2011.
Cliff Binder. Medicare Program Integrity: Activities to Protect Medicare from Payment Errors, Fraud, and Abuse, Congressional Research Service, 7/29/2011.
Center for Medicare Advocacy. Combating Fraud, Waste and Abuse in Health Care, 2/13/2012.
Department of Health and Human Services Office of Inspector General. Medicare Advantage Organizations’ Identification of Potential Fraud and Abuse, 2/1/2012.
Mark Kirk and Ron Wyden A ‘Smart’ Approach to Medicare Reform, The Hill’s Congress Blog11/2/2011.
Slow Start for Medicare’s New Fraud-Busting Computer Disappoints Lawmakers, The Washington Post, 2/23/2012.

Berwick, Donald and Hackbarth, Andrew. Eliminating Waste in U.S. Health Care. JAMA. April 11, 2012. The annual cost of Medicare and Medicaid fraud in 2011 ranged from $30 to $98 billion of health spending on these programs ($962 billion was spent on both programs in 2011, so these figures represent 3.1 to 10.2% of program spending).
Medicaid Health Plans of America. Medicaid Health Plans: Protecting Program Integrity, 2/1/2012.
Commonwealth of Virginia, Department of Medical Assistance Services. Options for Enhancing Fraud and Abuse Deterrence in the Virginia Medicaid Program, 12/1/2010.